Lift The Veil.
Parents Get Busy & Learn Why
'Medical Transition Is Not Place For a child.'
TReVoices & Everyone Else
Young Detrans Adults Are Among The Highest Part Of Society To Commit Suicide - The Suicide Epidemic Is Here
REGRET RATES AND LONG-TERM MENTAL HEALTH:
Even though data on trans people post medical transition show continuing high rates of mental health problems, higher suicide risk and physical health problems, dysphoria is mitigated by transition and mental health generally improves for most (not all) trans people according to most studies. A review confirming this was done by Cornell University. All of the abstracts can be found here.
A thorough review of these studies and the impact of transition on mental health and suicide is done on this website in this section. The overall message is that transition does seem to improve mental health. Studies with less lost to follow ups, as well as some review studies (Adams 2017, Marshall 2015) don’t seem to show any improvement is suicide risk. This indicates transition is not a fix all. However, the Cornell review does confirm very low regret rates (3.4% at the higher end) in populations of adults who were treated at a time with much more pressure not to transition due to stigma and under a gate keeping model.
Regrets following gender transition are extremely rare and have become even rarer as both surgical techniques and social support have improved. Poling data from numerous studies demonstrates a regret rate ranging from .3 percent to 3.8 percent. Regrets are most likely to result from a lack of social support after transition or poor surgical outcomes using older techniques.
There is generally a strong desire to paint social support and access to medical transition as sole factors in mental health. However, unfortunately even trans people in very supportive families and communities retain much higher rates of problems than scientific control groups.
While evidence suggests regret rates have historically been very low in the past, the research studies often have majors flaws.
Here a review highlights some of the problems involving tracking mental health and regret rates in earlier studies. Here’s how the Guardian summarized the results of a review of “more than 100 follow-up studies of post-operative transsexuals” by Birmingham University’s Aggressive Research Intelligence Facility (ARIF):
ARIF, which conducts reviews of healthcare treatments for the NHS, concludes that none of the studies provides conclusive evidence that gender reassignment is beneficial for patients. It found that most research was poorly designed, which skewed the results in favor of physically changing sex. There was no evaluation of whether other treatments, such as long-term counselling, might help transsexuals, or whether their gender confusion might lessen over time.
Of particular concern are the people these studies “lost track of.” As the Guardian noted, “the results of many gender reassignment studies are unsound because researchers lost track of more than half of the participants.” Indeed, “Dr. Hyde said the high drop out rate could reflect high levels of dissatisfaction or even suicide among post-operative transsexuals.” Dr. Hyde concluded: “The bottom line is that although it’s clear that some people do well with gender reassignment surgery, the available research does little to reassure about how many patients do badly and, if so, how badly.”
And a commentary on another review:
The final August 2016 “Decision Memo for Gender Dysphoria and Gender Reassignment Surgery” was even more blunt. It pointed out that “Overall, the quality and strength of evidence were low due to mostly observational study designs with no comparison groups, subjective endpoints, potential confounding (a situation where the association between the intervention and outcome is influenced by another factor such as a co-intervention), small sample sizes, lack of validated assessment tools and considerable loss to follow-up.” That “loss to follow-up,” remember, could be pointing to people who committed suicide.
And when it comes to the best studies, there is no evidence of “clinically significant changes” after sex reassignment:
The majority of studies were non-longitudinal, exploratory type studies (i.e., in a preliminary state of investigation or hypothesis generating), or did not include concurrent controls or testing prior to and after surgery. Several reported positive results but the potential issues noted above reduced strength and confidence. After careful assessment, we identified six studies that could provide useful information. Of these, the four best designed and conducted studies that assessed quality of life before and after surgery using validated (albeit non-specific) psychometric studies did not demonstrate clinically significant changes or differences in psychometric test results after gender reassignment surgery (GRS).
A. Despite low regret, rates mental health problems remain high indicating transition is not a fix-all for gender dysphoria
Even with very low recorded regret rates in the transgender population, most studies show continuing high rates of comorbid conditions and suicide risk relative to controls. Even the Olson-Kennedys (Johanna and Aydin, a married female/FtM couple and affirmative model activists) acknowledge gender dysphoria is often not actually cured by medical transition, only managed and that problems remain. In this way gender dysphoria does have some similarities to body dysmorphic disorder where things like cosmetic surgery do not actually alleviate distress long-term and mental health problems and anxiety about appearance continue. Cosmetic surgery is a more effective treatment for GD than for BDD. But it may not be the case for all and “shifting dysphoria” remains a problem in both conditions.
(Gender Odyssey, 2017):
If you are a parent as well, one of the concerns is going to be regret. I think as mental health providers we have a different relationship…But I think that we need to reorganize and think about what does regret mean? And where does it come from? When I think about who is talking about regretting transition or who is detransitioning, or retransitioning, or having a lot of those conversations. When you really whittle down, like what’s happening for that person, their gender identity has not changed. It was never and is not about gender identity, it is about, “I still have gender dysphoria. I didn’t know I was still going to have gender dysphoria. I didn’t know that I would still struggle in these ways and these places. I didn’t know that. I thought that I had gender dysphoria and would have intervention and I would feel better. And I don’t feel better.”
And so, people then make decisions to detransition because if, “I feel bad on either side, life is perceived as easier if I’m not seen as a trans person, than if I am seen as a trans person. And so, it is not about, “I was wrong about my gender. It’s about, “I am so surprised that I’m still kind of struggling a little bit and having a hard time but I still have gender dysphoria.”
Then if we look at people who detransition or retransition, a lot of those folks transitioned a) in adulthood, b) ten or more years ago. And so, the conversation really was about, you have this problem, we’re going to do this thing and then you won’t have this problem anymore…and so a false paradigm was set up. And so those are the folks that are very loud. And those are the folks who have a lot of opinions. And those are the folks who have a lot of opinions about people transitioning in earlier in life…It’s way harder to be inauthentic than to be authentic and have struggles.
The below quote was a response to a mother of a 16-year-old. The youth started to transition at 14 and the young person gets depressed after each transition step following a honeymoon period.
It is this idea around, there’s ups and downs. There are these honeymoon experiences. So, someone has a lot of gender dysphoria. They are able to start hormones, for trans masculine people, or testosterone. Testosterone starts impacting and creating changes relatively quickly. And so, there is a decrease in gender dysphoria. “My voice is too high. I don’t have any facial hair.” Like that stuff starts happening relatively quickly. So, gender dysphoria organized around physicality decreases. And so, there is kind of a honeymoon period. But all honeymoons, unfortunately, have an end. And gender dysphoria will increase again. And so, things will be more difficult. Your kids may be struggling again. And then chest dysphoria becomes a real necessity. And not only a desire, but a necessity.
And so, they will be struggling a lot because the more they show their body the more obvious it is they have breasts, right? To themselves and other people... So, there is an up and down, And I have a very strong belief that gender dysphoria, in a variety of forms, is a lifelong experience. If your child had chest dysphoria, they will not have chest dysphoria again after they have chest surgery.
So, there are pieces that are very addressable. But there are pieces that are just an ongoing life-long experience. (proceeds tell parents that this is likely to keep happening with their child and the youth will continue to dip into depression post each transition step and that GD never fully goes away) genital dysphoria will be next when they negotiate relationships…In my belief it is always there. Is it always present? Is it going to be something that your kids’, boys or girls or non-binary are going to have to navigate for the rest of their lives? I really do believe that. And I’ve had opportunities to talk to people who have transitioned 20 or 30 years ago. And they say that has absolutely been their truth and their experience.
Johanna Olson-Kennedy concurs this reality on a Straight Talk MD podcast: (link down)
And that being said, I don’t think that we, that I, would not like to promote the idea that social transition is the panacea, and that it’s going eradicate gender dysphoria, because it’s not. Gender dysphoria is the distress that arises from in congruence, and the in congruence is never gone. You can’t go back and unassign your gender or sex at birth. You can’t do that. And so, gender dysphoria shows up in a lot of ways. And we have to be mindful of that because what happens often is parents say “Well, we let you go on hormones, and we let you socially transition, then why are you still depressed?” or “why are you still anxious?” or “Why are you still self-harming?” And, as cisgender people, we can’t understand what it means to have gender dysphoria because we don’t have it, and so we have to be mindful, as clinicians to look for it, and see how it waxes and wanes over time.
And I think that we underestimate- so someone could be completely socially transitioned in childhood, they could go onto feminizing hormones at an early age, and they’re going to navigate high school when sexuality is sort of at a premium, with genitals that may or may not be what they resonate with, or what feels right for them. And so that’s going to be a big place of gender dysphoria for people, is, at the end of the day you have different challenges when you are non-disclosed, you’re completely perceived as your authentic self, but you are really restricted from entering into intimate spaces. Both with friends but also with potential partners, and that plays a big role in people’s lives, especially teenagers.
When talking about a client who, having gone through transition, still had nagging feelings of being incomplete, Michelle Angello (Gender Odyssey, 2017) said this:
And for some it can be the panacea and for others, again its complex. And so there are going to be other things and now we get the opportunity to work on them.
This detransitioner also notes that despite low regret rates he observed:
I’ve seen the statement made many times that “the rate of regret for gender transition is very low”, generally quoted between 1 -3 % or so. This information is used as evidence that we should not be so concerned with the problem of detransition. People identifying with a certain gender and wanting to transition is enough proof that transition is right for them, and therefore there is no need for any in-depth screening. If someone identifies with a certain gender and wants to transition then clearly that is the right thing, as evidenced by low regret rates. Also, there is no reason to look at different ways to deal with dysphoria, because we have this great treatment that already works.
However, there are several problems wit
h this which are:
-The reported measures of regret rates don’t actually measure regret rates.
-Regret rates are not the sole measure of good / bad outcomes.
-The demographics of transitioners today are not the same as those in the past.
-Gender transition and improving people’s quality of life, doesn’t mean there aren’t less invasive ways to get the same improvement.
Because I transitioned 20 years ago, I know many MtF transitioners that were in my cohort 5-10 years before. What I see is concerning. I am the only one out of them that has detransitioned, and most of them would not say that they regret their transition and continue to go by feminine pronouns and feminine names. In terms of life outcomes, I would say economically they are mostly doing well. However, socially they are struggling. Most of them are alone. I see a lot of social anxiety, people being unwilling to leave the house. In addition, they still continue to deal with dysphoria and have emotional difficulties.
This is not a good thing, some people would say these difficulties are due to oppression and by reducing this oppression it would reduce or eliminate these difficulties. I definitely believe that oppression is a large factor in some of the things that are awful about being transgender. I oppose those that intend to make the world worse for trans people. However, I do not think it is the sole source of these difficulties.
Here an FtM who is on an colostomy bag and has undergone 33 surgeries due to phalloplasty complications admits medical transition is not a panacea.
Despite regret rates being low, many serious problems remain for trans people overall post transition. Without a control group it is impossible to know for sure how these individuals would fair if they lived in a world where medical transition was not possible (most of human history). There are some cultures where GNC people are accepted and they seem to do well without medical treatment (In Fiji and among the Zapotec). This professional research and consulting firm found low quality evidence for benefits of SRS and found weak evidence to support giving children Lupron.
Over the past two decades, Hayes, Inc., has grown to become an internationally recognized research and consulting firm that evaluates a wide range of medical technologies to determine the impact on patient safety, health outcomes, and resource utilization. This corporation conducted a comprehensive review and evaluation of the scientific literature regarding the treatment of GD in adults and children in 2014. It concluded that the practice of using hormones and sex reassignment surgery to treat GD in adults is based on “very low” quality of evidence:
Statistically signifcant improvements have not been consistently demonstrated by multiple studies for most outcomes. Evidence regarding quality of life and function in male-to-female (MtF) adults was very sparse. Evidence for less comprehensive measures of well- being in adult recipients of cross-sex hormone therapy was directly applicable to GD patients but was sparse and/or contradicting. The study designs do not permit conclusions of causality and studies generally had weaknesses associated with study execution as well. There are potentially long-term safety risks associated with hormone therapy but none have been proven or conclusively ruled out. (31,32)
Regarding treatment of children with GD using gonadotropin releasing hormone (GnRH) agonists and cross- sex hormones, Hayes, Inc. awarded its lowest rating indicating that the literature is “too sparse and the studies [that exist are] too limited to suggest conclusions. (31)
B. Are regret rates increasing with more transitions & people transitioning at younger ages?
Regret rates appear to be increasing Acknowledging the results of the Cornell review, there is some anecdotal information that regret rates are going up, even among the numbers of adult transitioners who transitioned under the gatekeeping model. It’s difficult to tell as follow up studies have inherent major problems tracking true regret rates.
A scientist in Britain says this:
He said 40% of people who undergo vaginal reconstruction surgery experience complications as a result, and many need further surgery, and 23% of people who have their breasts removed "feel uncomfortable with what they've done".
He added: "What I've been seeing in a fertility clinic are the long-term results of often very unhappy people who now feel quite badly damaged.”
"One has to consider when you're doing any kind of medicine where you're trying to do good not harm, and looking at the long-term effects of what you might be doing, and for me that is really a very important warning sign."
This transgender healthcare expert doctor is seeing more regretters:
Over the next six months, another six people also approached him, similarly wanting to reverse their procedures. They came from countries all over the Western world, united by an acute sense of regret.
Professor Miroslav Djordjevic:
At present, Djordjevic has a further six prospective people in discussions with his clinic about reversals and two currently undergoing the process itself.
Reattaching the male genitalia is a complex procedure and takes several operations over the course of a year to fully complete, at a cost of some R290,000.
Those wishing the reversal, Djordjevic says, have spoken to him about crippling levels of depression following their transition. Some have even contemplated suicide. "It can be a real disaster to hear these stories," says the 52-year-old.
Also from the same article:
Djordjevic, who has 22 years' experience of genital reconstructive surgery, operates under strict guidelines. Before any surgery, patients must undergo psychiatric evaluation for between one and two years, followed by a hormonal evaluation and therapy. He also requests two professional letters of recommendation for each person and attempts to remain in contact for as long as possible following the surgery. Currently, he still speaks with 80% of his former patients.
"I'm afraid what will happen five to ten years later with this person," he says. "It is more than about surgery; it's an issue of human rights. I could not accept them as a patient as I'd be afraid what would happen to their mind…"
Over the past two decades, the average age of his patients has more than halved, from 45 to 21…As a result of the issues he is seeing the the lowering of ages, he does not support those advocating for medicating children.
Djordjevic feels differently, and says he `has deep reservations about treating children with hormonal drugs before they reach puberty - not least because blocking certain hormones before they have sufficiently developed means they may find it difficult to undergo reassignment surgery in the future.
"Ethically, we have to help any person in the world starting from three to four years of age, but in the best possible way," he says. "If you change general health with any drug, I'm not a supporter of that theory."
These are profoundly life-changing matters around which he - like many in his industry - feels far better debate is required to promote new understanding. But at the moment, it see